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Rural hospitals across the country are in a difficult spot right now. COVID-19 is hitting them harder than many metropolitan hospitals as they deal with issues of lower staffing.According to the National Center for Biotechnology Information, about 20% of our nation’s population lives in rural areas, yet less than 9% of our nation’s physicians practice there.Add on the fact that according to CDC data, COVID is killing rural Americans at a rate 3.5 times higher than those living in metropolitan areas, and this issue is affecting staff and patient care.“I’m very worried about rural health care because rural health care is teetering on the brink right now,” said Dr. Kurt Papenfus, an ER doctor at Keefe Memorial Hospital in rural Cheyenne Wells, Colorado. “There’s a darkness in this illness that I can’t say I’ve said about any other illness.In late October, Dr. Papenfus contracted COVID-19 as he was traveling back from the Northeast to visit his daughter.“I was very cognizant and was wearing a mask at all times, social distancing, and washing my hands,” Papenfus said. “But I remember having this thought on the train that this is a super-spreader event.”When he got home, Papenfus got tested and was confirmed positive for COVID-19. The diagnosis put Keefe Memorial in a tailspin as he served as the only ER doctor in the small 25-bed hospital.“We are a trauma level four hospital so keeping that physician on staff 24/7 is what we are required to do,” said Stella Worley, Keefe Memorial’s CEO. “And it is getting to be more of a challenge to have hired physicians out here in rural [America].”Within minutes of learning of Dr. Papenfus’ COVID-positive diagnosis, Worley was on the phone with several different hospitals working to find a replacement. Within a few hours, they had settled on a former ER doctor who moved to another hospital in Texas a few months prior.After she agreed, Keefe Memorial paid the doctor to drive 10 hours from Texas to Colorado and fill in immediately as Papenfus recovered at home for the next two weeks.“Worst-case scenario is you would have to divert patients if there’s no one in the door to care,” said Worley.Populations in rural America tend to be older, poorer, and less insured than the nation at large, according to the National Conference of State Legislatures.Since 2010, hospital closures in rural America have been growing as there have been 118, including 17 last year.The closures only exacerbate a growing lack of health care coverage in rural America, said Dr. Dan Derksen, a rural health care expert and family physician“Once a critical access hospital (25 beds with a 24/7 emergency department and at least 35 miles from another facility) closes, they almost never come back,” he said. 2756

SACRAMENTO, Calif. (AP) — The director of California's unemployment benefits department, Sharon Hilliard, said she will retire at the end of the year. The announcement Friday comes after the agency has been overwhelmed by more than 15 million claims during the coronavirus pandemic. The agency has a backlog of more than 900,000 people still waiting to receive benefits. Hilliard has said the backlog won't be cleared until the end of January. California Labor and Workforce Development Agency Secretary Julie A. Sue praised Hilliard for helping reset the agency's culture. Republican Assembly Jim Patterson urged the governor to appoint a replacement from outside the agency. 684

SACRAMENTO, Calif. (AP) — A man charged with killing a rookie California police officer made his first brief court appearance Monday wearing a four-inch gauze pad covering what officials said was a self-inflicted injury.Adel Sambrano Ramos was appointed a public defender during a five-minute court hearing, and spoke only to acknowledge his name.Ramos, 45, faces a murder charge that could bring him the death penalty in Wednesday's slaying of 26-year-old Sacramento Officer Tara O'Sullivan. He's also charged with attempting to murder her training officer and with possessing two illegal assault-style rifles.He did not enter a plea.Assistant Chief Deputy District Attorney Rod Norgaard defended police from criticism that they took 45 minutes to rescue O'Sullivan with an armored vehicle because they were pinned down by rifle fire that could penetrate standard bulletproof vests."There was nothing that could have been done to save her life," he said after the hearing. "The nature of that injury is such that it could happen in an emergency room and she would not be save-able. So I find it very disheartening that people are criticizing the police response time to evacuate her. That has no merit whatsoever."He also took exception to questions of whether O'Sullivan was properly trained."Nothing in the training or lack thereof is the cause of this," he said. "There is an individual responsible for this, not law enforcement."Assistant Public Defender Diane Howard declined comment, as did Police Chief Daniel Hahn, who sat quietly in the back of the courtroom. Hahn was one of at least a dozen uniformed police officers and deputies watching as the hearing unfolded.Ramos was shackled at the hands, waist and ankles and surrounded by three deputies in the courtroom's holding cage. Two more stood just outside the cage.He was wearing a standard orange jail uniform during the hearing, though officials said that has been taken away from him at the jail after he tried to harm himself Sunday morning.Ramos suffered "some self-inflicted head wounds. He had smashed his head against a bed frame in his cell," Sacramento County Sheriff's Sgt. Tess Deterding said before the hearing.Jail employees immediately stopped him from further injury and took him to an outside hospital, she said. He was returned to the jail 12 hours later.He's now in a psychiatric wing of the jail "where we've taken even further precautions to make sure he doesn't hurt himself like that," Deterding said.He is under constant watch in what is called a safety cell, which has no bunk or other furnishings."Obviously we can't take away the walls and floor," she said, but "there's nothing inside the room. It's just basically four walls."He is provided a thin mattress and what is known as a suicide smock instead of regular jail garb: "It's tear-resistant, things like that, they can't turn it into a noose," she said. There are mental health employees in that unit in the event they are needed or requested by Ramos.Ramos also has had no contact with other inmates since he arrived.Memorial services for a O'Sullivan are set for Thursday at the Bayside Church's Adventure Campus in Roseville, California. She was fatally shot during a domestic violence call as she and other officers helped an unidentified woman pack her belongings from the garage of a North Sacramento home, authorities said.Authorities said Ramos was heavily armed with assault rifles, a shotgun and a handgun and fired dozens of times at officers during an hours-long standoff before surrendering. 3558

SACRAMENTO, Calif. (AP) — California's incoming governor said Tuesday his transition started with a "reality check" as the state contended with a mass shooting and two deadly wildfires.Lt. Gov. Gavin Newsom appeared alongside fellow Democrat and outgoing Gov. Jerry Brown for the first time since he was elected California's 40th governor last week."That puts everything in perspective," Newsom said of the tragedies, standing behind a large brass bear that former Gov. Arnold Schwarzenegger installed in front of the governor's office during his tenure.Newsom said he's focused for now on staffing his administration. The governor appoints hundreds of people who serve at top levels of state agencies and departments. He announced last week that he'd picked former Hillary Clinton aide Ann O'Leary to be his chief of staff and Ana Matosantos, a former chief of finance for the state, to be his cabinet secretary.He and Brown did not offer details of their discussions."Pick an issue. We've had a chance to dialogue at least broadly about it," Newsom said.With fires raging on both ends of California, one of them the deadliest and most destructive in the state's history, Newsom sidestepped questions about what action should be taken against utilities if their equipment is found to be responsible. The fires started near the time and place where Southern California Edison and Pacific Gas & Electric reported equipment irregularities, but no cause has been determined."I'm going to assess the facts first before I opine," he said.Newsom called legislation enacted last year to improve forest management and protect utilities from financial ruin "a good first step, obviously a work in progress." The measure included money to clear dead trees from fire-prone areas and made it easier for utilities to pass along the costs of wildfire lawsuits to their customers. California is one of two states with a legal standard that holds utilities entirely liable if their equipment causes a wildfire.Brown said California is "pretty well maxed out" from fighting several deadly wildfires and he's grateful for the help from surrounding states and the federal government.He said the state is doing everything possible to prevent fires, but "some things only God can do.""This is unprecedented, or what I call the new abnormal," Brown said. "The winds are faster, the temperatures are hotter. The soil and vegetation is dryer. This is unprecedented. And it's a tragedy, and we as human beings have to be humble in the face of it, but also resolute and determined." 2568

Running out of ideas to entertain your kids? A California writer and performer took his ideas, got crafty on Instagram and it has kids everywhere giggling. Avery Monsen took us behind the scenes of the "Super Secret Secret Club."Monsen has a lot of day jobs these days. He writes and illustrates books for children and adults, he's done some acting and he's been in commercials. But these days, Hollywood isn't doing much. One day a friend of his asked him to make a video to help entertain his own kids, who were quite literally climbing the walls.“He knows that I have this sort of grab bag of circus and magic tricks and skills that are very rarely actually useful in life, but they are useful in entertaining children,” said Monsen.And so, the Super Secret Secret Club was born. You can find it online, on Instagram or on Instagram TV, and it is full of good, clean fun.“It’s just a bunch of cardboard and duct tape, but there’s also all these strings that go everywhere we’re probably going to lose our security deposit on this place, whoops,” said Monsen.There's no market research about what kids like and Avery describes himself as a someone who is quite possibly still a kid.“I think I’m just making things that I like is the truth, and my taste is the taste of a 4 and 9-year-old. The things that I think are funny are the things a 4-year-old thinks are funny,” said Monsen.He also made activity pages for kids. There's puzzles and games and even a Super Secret Secret Club membership card.“I knew that kids were going to get bored and antsy in the quarantine times. I felt the least I could do is make some fun videos for them," said Monsen.Monsen isn't in it for the clicks, likes or comments. He's purely helping kids laugh, for free. And admittedly, he says, he needed a project and he happens to have a garage full of crafts as well as a huge paper maché pet rock named Anthony, who talks, by the way.“Which maybe means I’m a bit of a hoarder. I have a lot of cardboard. We had just moved into this new apartment which had a garage. Before that, I was doing projects in the living room which made my wife very sad,” said Monsen.His content has kids everywhere giggling and Monsen says, “when you’re devoting your entire week to making a silly video and you’re not getting paid for any of it, getting videos of kids enjoying it and doing the activities and laughing really, really makes it worthwhile.”Certainly, it’s a worthwhile effort from a guy who has all the tricks, trades and a huge knack for making all the little ones laugh during a time when giggles are hard to come by. 2603

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